The safety of antidepressants in pregnancy

Maternal antidepressants are implicated in ADHD, but so is maternal depression

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The safety of antidepressants in pregnancy is controversial, partly because of profound methodological difficulties in separating the fetal effects of antidepressants from those related to maternal depression (confounding by indication). One central concern is the potential impact of these drugs on fetal brain development. Such effects may be subtle and possibly only detectable years after exposure, such as an increased susceptibility to (multifactorial) neurodevelopmental conditions.

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Women are unaware of pregnancy risks linked with sodium valproate

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Doctors are being asked to make sure that women and girls with epilepsy know about the risks of taking sodium valproate during pregnancy, after a survey found that half of those questioned were unaware that it could harm the fetus.

The charities Epilepsy Action, Epilepsy Society, and Young Epilepsy conducted a survey earlier this year, in conjunction with the Medicines and Healthcare Products Regulatory Agency (MHRA), of 2788 women aged 16 to 50 with epilepsy.

Oral antifungal is associated with increased risk of miscarriage

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Use of the oral antifungal drug fluconazole during pregnancy was associated with an increased risk of miscarriage in an analysis of 1.4 million pregnancies in Denmark published in JAMA.

Vaginal candidiasis is common during pregnancy. Although intravaginal formulations of topical azole antifungals are the first line treatment for pregnant women, oral fluconazole is often used in cases of recurrence or severe symptoms or when topical treatment has failed.

Antenatal and postnatal mental health: clinical management and service guidance

Antenatal and postnatal mental health: clinical management and service guidance

This updated guideline from NICE makes recommendations for the recognition, assessment, care and treatment of mental health problems in women during pregnancy and up to 1 year after childbirth, and in women who are planning a pregnancy.

 

 

Home rather than hospital for low risk pregnancies

Extract from National Health Executive

398BAB -8514“New guidelines from NICE could see thousands more babies born outside of hospital every year.

Nearly 700,000 babies were born in England and Wales last year, nine out of 10 of whom were delivered in hospital under the ultimate supervision of obstetricians, but NICE wants women to be given greater freedom to choose where they give birth.”

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Eyes on Evidence: April edition

This month in Eyes on Evidence

E-cigarette awareness and use to quit smoking
A survey suggests that awareness and use of e-cigarettes has increased over the past few years, but a randomised controlled trial indicates that the products are only modestly effective at helping people to quit smoking.

Beta-2 agonists and exercise-induced asthma
A Cochrane review has assessed the effects of short and long-acting beta-2 agonists for the prevention of exercise-induced asthma in adults and children; the majority of included studies assessed the effect of a single dose of a beta-2 agonist. The Medicines and Healthcare Products Regulatory Agency has previously issued advice recommending that long-acting beta-2 agonists should not be prescribed for the relief of exercise-induced asthma symptoms in the absence of regular inhaled corticosteroids.

Blood pressure control with home telemonitoring and pharmacist management
A US-based cluster randomised trial indicates that home telemonitoring with pharmacist medication management provides better blood pressure control than usual primary care, even once telemonitoring has finished.

Risk factors for congenital abnormalities
A prospective study of a UK multi-ethnic birth cohort suggests that consanguinity is a major risk factor for congenital abnormalities, in particular in children of parents of Pakistani origin.

Antidepressant use late in pregnancy and risk of postpartum haemorrhage
A cohort study of women with low income in the USA suggests that use of antidepressants near delivery is associated with an increased risk of postpartum haemorrhage.

CT scans in childhood or adolescence and risk of cancer
A population-based cohort study in Australia suggests that people who undergo CT scans in childhood or adolescence are at increased risk of developing solid, lymphoid and haematopoietic cancers.

Evidence Updates
NICE has recently published an Evidence Update on:
Alcohol-use disorders: preventing harmful drinking

Eyes on Evidence – October 2013

 

 This month in Eyes on Evidence
A Cochrane review notes that training in patient-centred approaches for healthcare professionals may have positive effects on patients’ experiences of consultation processes.
A Danish case-control study finds that use of glucocorticoids is associated with an increased risk of venous thromboembolism.
A cohort study shows that women who gain large amounts of weight during pregnancy are at increased risk of needing operative delivery.
A prospective population study suggests that, compared with bag-valve-mask ventilation, advanced airway management is associated with lower rates of favourable neurological outcomes after out-of hospital cardiac arrest.
A study suggests that British Pakistani girls may be less active than British white girls during school break times.
We would like your examples of how health and social care staff are helping to improve quality and productivity.
NICE has recently published Evidence Updates on:
  • Obsessive-compulsive disorder